Rarely an adult may develop intestinal colonization with Clostridium botulinum with absorption of toxin and clinical botulism. This is the adult (or older pediatric) version of infant botulism.
Predisposing conditions:
(1) achlorhydria
(2) inflammatory bowel disease (Crohn's disease or ulcerative colitis)
(3) history of recent gastrointestinal surgery
(4) history of recent antibiotic therapy (with suppression of the normal GI flora)
Features:
(1) clinical botulism
(2) failure to demonstrate botulinum toxin in foods (although C. botulinum spores may be present)
(3) assays of feces for botulinum toxin are positive
(4) anaerobic cultures of stool are positive for Clostridium botulinum or Clostridium baratii
(5) serum assay for botulinum toxin may be negative in mild intoxications
(6) no evidence of wound botulism
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